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Pain Management

Take Care of Your Chronic Pain to Take Back Your Health

Arpan Patel

man out of breath while running

No matter where it originates, pain is all in your head.

It’s true. Your brain receives the signals coming from your nervous system, identifies the location and determines the severity. From there, your brain tells you how to react to the pain. The higher the intensity of pain and emotion, the bigger the warning your brain sends.

When you have chronic pain, those pain signals don’t stop. That can leave you feeling terrible all the time or constantly achy with recurring bouts of debilitating pain.

Pain and tolerance varies from person to person. However it feels and whatever your threshold, there’s help.

Chronic pain is manageable.

You might feel like pain is a part of life. A sign of aging. And there’s little you can do about it.

That’s not true, says Arpan Patel, MD, a pain management physician at The Iowa Clinic’s West Des Moines Campus.

“There’s a big misconception that taking pain medication indefinitely or getting surgery are the only answers,” he says. “There’s a lot in between doing nothing and going down those paths. There are things that can be done for age-related arthritis or that pain you’ve been struggling with for the past 10 years but just haven’t done anything about because you didn’t know there were options.”

Since pain is so subjective, treatments vary to relieve all types. All of them are more conservative options you can try out or blend together to provide the pain relief you need without going under the knife.

“You have to fail these more conservative treatments before insurance will even cover surgery. But also, you want to make sure you try the easy things before you sign up for a surgery you can’t take back,” Dr. Patel says.

There’s more to pain relief than medication.

It’s no secret that opioids have their issues. But some people only need a little prescription pain medication here and there to get around. With the help and monitoring of a pain physician, pain meds may help you manage your condition.

But it’s not the only way to get long-term relief or find enough to function, Dr. Patel says. He calls these the “bread-and-butter pain treatments” — many of which may be new to you.


No, these aren’t just for labor. An epidural is actually any injection that goes into the epidural space surrounding the spine. And that can be anywhere along your vertebrae, not just in the lower back, to target nerve pain. Even if your pain is more in your leg or arm, it might be radiating from the nerves in your spine, where an epidural can help.

“An epidural is at a very specific location. If you get some degree of benefit, even if it’s for a short period of time, we know that’s where the pain is coming from,” Dr. Patel says. “A lot of times that gives a surgeon diagnostic information as well. So there’s a reasonable chance that if they fix the underlying problem at the same location, you’ll benefit from surgery.”

Facet Joint Injections

Like the epidural space, the facet joints are also located along the spine. Facet interventions are commonly used for arthritic pain or general lower back pain. An anti-inflammatory steroid is injected into a specific joint, helping to relieve aching in the low back or pain that radiates down the back and to the thighs. Facet injections are also used in the neck.

With facet joint injections, you typically feel relief in a day or two. So you can get back to work or activity almost immediately. The relief can last for a long time, but you may need additional injections if your pain returns.

Radiofrequency Ablation

You’ve probably used heat to help heal an aching back or warm up a joint. Radiofrequency ablation follows similar principles, but at a much higher intensity. Radio waves of heat actually burn the nerves where your pain is stemming from, providing relief three to 12 times longer than an epidural.

“If you have arthritic pain, that’s where you may benefit from local steroid injections or ablation,” Dr. Patel says. “Often, for that middle-age back arthritis, you might come in for a couple months for injections or an ablation, feel better and be done. That’s probably the most common situation.”

For most types of pain, it’s a mix of these interventions that provide long-term relief combined with more conservative approaches for the day-to-day.

“Conservative treatment typically includes some form of exercise, either at home or at physical therapy, medication (not pain medication) and maybe an epidural every three to four months,” Dr. Patel says. “For a lot of patients, those three things working in sync ends up being sufficient.”

You don’t have to wait until pain becomes “chronic.”

Chronic pain is often defined as pain that is ongoing and has lasted for six months or more. But when it comes to relieving pain so you can get back to life as usual, there’s no definitive time requirement, Dr. Patel says.

“The timeline doesn’t really matter. You just have to have pain that you or your primary care provider feels is coming from somewhere or is from some definite diagnosis. And they need a pain specialist to explore it and treat it. That’s the best time to get a pain doctor, irrespective of how long you’ve been in pain.”

“While a primary care provider will typically refer you to a pain doctor, you don’t need a referral. You just need pain of some type that you haven’t been successful in treating,” he adds. “We can assess your pain, find the source and start you on the path to treatment for chronic pain.”

Arpan Patel

ArpanPatel , MD

Arpan Patel, MD joined The Iowa Clinic to be part of a multi-specialty medical practice. Working with primary care physicians and surgeons allows for a more collaborative environment and ultimate transparency in patient care.

Originally, Dr. Patel completed his residency in anesthesiology but quickly found he missed the follow up other physicians had with their patients. He refocused his specialty to pain management where he was able to obtain that same continuity of care. He considers implementing treatments and seeing patients receive functional benefits the most rewarding part of his job.

Dr. Patel moved to Iowa because he enjoyed his fellowship experience at the University of Iowa. Living here has taught him the true meaning of kindness and the importance of family values. In his free time, he enjoys reading interior design magazines, expanding his passion for cars, and spending time with his wife.